Healthcare Provider Details

I. General information

NPI: 1467464222
Provider Name (Legal Business Name): PETER ALEXANDER BIDNY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

5706 CRAIN ST
MORTON GROVE IL
60053-3038
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-3749
  • Fax: 224-610-2909
Mailing address:
  • Phone: 224-610-3749
  • Fax: 224-610-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: